Executive Physical Therapy PT

Primary specialty

Physical Therapy Clinic/CenterTaxonomy code 261QP2000X

Legal business name

EXECUTIVE PHYSICAL THERAPY PT

Practice address

7802 Roosevelt Ave Ste 212
Jackson Heights, NY 11372-6626

Phone

(718) 426-1515

Fax

(718) 426-0133

NPI assigned

Feb 1, 2012

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Prof. Martha Ceculia Anibal, PT

Title

Physical Therapy Administrator

Phone

(718) 426-1515

Specialties & licenses 1

Addresses

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1328054400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1361491200000",
    "number": "1497027700",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "7802 ROOSEVELT AVE STE 212",
            "city": "JACKSON HEIGHTS",
            "state": "NY",
            "postal_code": "113726626",
            "telephone_number": "718-426-1515",
            "fax_number": "718-426-0133"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "7802 ROOSEVELT AVE STE 212",
            "city": "JACKSON HEIGHTS",
            "state": "NY",
            "postal_code": "113726626",
            "telephone_number": "718-426-1515",
            "fax_number": "718-426-0133"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "EXECUTIVE PHYSICAL THERAPY PT",
        "organizational_subpart": "NO",
        "enumeration_date": "2012-02-01",
        "last_updated": "2013-02-22",
        "status": "A",
        "authorized_official_last_name": "ANIBAL",
        "authorized_official_first_name": "MARTHA",
        "authorized_official_middle_name": "CECULIA",
        "authorized_official_title_or_position": "PHYSICAL THERAPY ADMINISTRATOR",
        "authorized_official_telephone_number": "718-426-1515",
        "authorized_official_name_prefix": "Prof.",
        "authorized_official_credential": "PT"
    },
    "taxonomies": [
        {
            "code": "261QP2000X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Physical Therapy",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• Providers in Jackson Heights, NY by specialty
• Physical Therapy Clinic/Center in New York

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 22, 2013; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.